Following a request on Twitter, this post summarises some of the major research developments in dementia science between the time when my book The Fragile Brain was submitted (March 2016) and its publication last month (November 2016).

Treatments

The big clinical news is surely the failure of the solanezumab trial, based on the amyloid cascade hypothesis. Some researchers reacted by giving reasons why the failure didn’t kill the hypothesis; others remarked that you can’t kill something that’s already dead. Apart from its implications for research, this is another setback for patients desperate for good news.

Lifestyle

Good news may yet arrive from treatment trials, but we got some by another route this year, courtesy of big epidemiological studies such as Langa et al. and Matthews et al.. These support the idea that dementia rates may be slowing, at least in Western countries like the UK. That suggests that the lifestyle changes people have made so far may be having an effect.

These changes are sizeable. In the UK, for instance, smoking has dropped from 46% to 19% of adults since 1974, according to the Office for National Statistics. If so much change is possible, perhaps there’s hope for other risk factors like overeating, pollution, and physical inactivity. It would help if governments would take them more seriously, though there are hints of progress here too, such as the new UK sugar tax. Countries in which smoking rates remain high and diets are becoming more Western are storing up trouble – and expense – for future generations.

Research

In research, one obvious change (certainly since I began work on The Fragile Brain) is that neuroimmunology – and the broader acceptance that blood factors can and do affect the brain far more than previously thought – is now mainstream. For example, the journal Neuropsychopharmacology has just issued a table of contents on the topic (Volume 42, Issue 1, January 2017). Emphasis on diabetes and depression as risk factors has increased accordingly, given the importance of inflammation in these disorders. Research into the gut and microbiome, and their potential impact on ageing brains, is also gathering pace (e.g. Sampson et al.).

Complementing this is the growing understanding that the brain’s non-neuronal cells – such as astrocytes, microglia, oligodendrocytes, pericytes and endothelial cells – really matter for neurons’ and synapses’ wellbeing. These formerly neglected cells, and the vascular system, are vital for keeping the brain healthy into old age (see e.g. Ma et al.).

Efforts continue to make the impact of new methods, such as organoids, ‘omics’ and neuroimaging, felt in neurodegeneration research, and to organise the masses of data they produce (see e.g. Rollo et al.). It’s becoming clearer that lipids, and the cell membrane, are more important players than previously realised, which potentially opens up new treatment and dietary avenues for research. For proteins, the importance of variants in genes other than ApoE, such as TREM2, is becoming more apparent, and ApoE studies are also branching out.

This is a brief summary of recent developments; there’s much more than I’ve covered here. It’s a fast-moving field, and 2017 should bring plenty of advances in basic research. And treatments? Well, here’s hoping. Perhaps some of the other antibody trials, or alternative approaches such as insulin, will produce encouraging results.

Whatever happens in 2017, in dementia research and elsewhere, I wish you a successful new year.

The Fragile Brain was the most difficult project I have ever attempted. Dementia science is exceptionally complicated, even by the high standards of brain research. I have done my best to distill down a vast literature and to explain the intricate web of findings as clearly as possible.

I hope that readers will find the book useful – and also encouraging, because I do think that we are approaching something of a golden age for dementia research. Funding is rising, as is public awareness, while dementia rates may be falling at last. New techniques are accelerating the science. New treatments – after a long list of failures – are finally emerging.

The Fragile Brain was written in part to provide a lucid summary of a tough but important topic. It also arose from my own need to know more about dementia and other age-related brain conditions. Like very many other people, I have recently had personal experience of how these illnesses can stress and torment a family. That history was always in my thoughts as I wrote the book. If you are affected directly or indirectly by dementia, your experience will likely weigh heavily on your mind. I wish you well.

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I’m a writer, and like many writers I’ve got what a friend of mine calls “text hunger” – if it’s there, I’ll read it. One such recent encounter was with one of those little leaflets that come with medicines.

Two things struck me about this text. The first, of course, was the bizarre range of symptoms I’d risk by taking the pills. Medicines by Big Pharma, side-effects by Goya. As it happened, I didn’t lapse into unconsciousness, my skin did not peel off and my eyes remained resolutely un-yellowed. (It was only a sinus infection!)

The second thing that struck me was the way the leaflet’s writers kept exhorting me to contact my doctor if I had any problems. As one of the side-effects was coma I’m not sure how they envisaged that scenario; but that’s by the by. I was left with the strong impression that wherever the writers lived, it was somewhere with truly amazing healthcare services.

The same impression seeps like a miasma of optimism from Internet sites about health-related issues. Any queries? Go talk to your physician, they’ll sort it out. Got a headache? (It could be a brain tumour!) Ask your GP; they’ll calmly steer you through your anxieties. Afraid your fever might be Ebola, not flu? Just get an appointment and check.

As for the frequent media reports of wonderful medical advances, with their tales of current patients carefully examined and lengthily treated, and future patients whose medications will be personalised to their particular circumstances, they seem designed to raise unrealistic expectations.

Where is this fabulous land in which doctors sit, primed and eager, in their surgeries, with all the time in creation to soothe, heal and most of all listen? It isn’t here. Nor, I suspect, is it where you are (though I’d be delighted to learn otherwise). Unrealistic? It’s like reading the Narnia books, except I’d be less surprised if I met a talking animal.

How does anyone think we are going to find the time and money to do all this personalising of medicine? Here in the UK we can barely afford the current NHS. Despite swallowing vast quantities of funding and research time, problems like obesity, alcoholism and dementia aren’t about to be ticked off the healthcare agenda. Medics may be able to do astonishing things like helping the paralysed to walk, but there are still an awful lot of common conditions – from arthritis to Alzheimer’s, chronic fatigue to Crohn’s disease – which they struggle to manage successfully, let alone cure.

Now and again the media, presumably tired of simulating Dr Pangloss, flips into attack mode and screams about hospitals in special measures and patients expiring for lack of medical attention. We have those round here too: a ring of hospitals so poorly that we can only pray we never get sick enough to need them. But over-emphasising the negative is no more helpful than dishing out happy positives. When a friend of mine needed urgent care, it was given with quick and kind efficiency.

Plus or minus, public visions of the NHS seem worryingly detached from the reality. I heard a top doctor on the news the other day fretting about how paying doctors to diagnose dementia could affect the doctor-patient relationship. What relationship would that be? Every time I visit my surgery I see a different person. They are almost all kind and pleasant, but they have a demoralising aura of hurry and overwork, as if patients are not so much people as problems to be solved, with a pill if possible or a referral if not.

Our GPs are so busy that same-day appointments are a rare treat. This may be because they are currently overwhelmed by people panicking about Ebola, as a friend sourly suggested, but I doubt it. The NHS I know – the real one, not the media fable – has had these problems for years. All those siren voices encouraging people to book appointments may not have helped, but the problems run deeper than mere anxiety.

Moreover, not everyone panics. There are many patients who, like me, ruinously distort their nation’s health statistics by not going near a doctor unless they’re driven there by nagging friends and relatives. A cold or flu? Pile on the painkillers, whip up a honey-and-lemon. Lingering coughs and strange twinges? Wait a week or two and see if they get any worse. I had my sinus infection for months before I bothered the doctor with it, and that was only because I was getting so deaf it was making conversations difficult.

When I did finally approach the surgery, there wasn’t a hope of actually seeing a doctor that week. I managed to get a prescription purely by telephone, from a complete stranger whose scheduled morning call was three hours late. The consultation may have lasted as much as five minutes. And the pills didn’t work, so I had to go back again.

This is the real NHS: good people doing their best in near-impossible situations. They can fix many basics. There’s a huge amount they can’t fix, because medicine just isn’t that accomplished yet.

But it’s not just that. Patients and future patients ramp up the problems by smoking, overeating, drinking too much, sitting around all day and/or refusing to take responsibility for their own health. That’s you and me both, and the world and his wife or partner, egged on by the media, politicians and various industries whose business models depend on our laziness, greed, short-termism and anxiety.

Why is it so difficult for people in the public eye – politicians, doctors, media commentators – to say so? Why the polished pangloss or the exaggerated panic? The NHS has enough to deal with without these crazed swings from love to hate, from praise to vituperation. And those of us who see the NHS as a national treasure need to think clearly about its needs, which are our needs – especially with a general election looming.

How can we do that if no one will tell us the truth, unvarnished, untarnished and without obfuscation and propaganda? I know humankind cannot bear very much reality (Mr Eliot said that, so it must be true). But surely we could bear a little more than this.

Like this:

A recent piece in Discover magazine highlights research on changes in brain size over the last 20 000 years. Contrary to what you might expect, the findings seem to point to decreasing size up until very recently (the last century or so, when better nutrition and public health measures became available). The article doesn’t mention gender differences (men typically have bigger brains than women) or health issues (some big brains can be a sign of big problems), but it suggests various hypotheses about why the changes may have happened, making for an entertaining read.

(Not as entertaining, however, as Kurt Vonnegut’s novel Galapagos, one of my ten books every scientist should at least know about, in which one of the hypotheses is delightfully explored. Vonnegut takes the idea that we’re dumbing down, living through the rise of the ‘idiocracy’, and extrapolates it far into the future.)

Rumour has it that IQ measures, those sure and certain guides to human ability, are also not soaring like they used to. (That’s debatable; a recent meta-analysis confirms the Flynn effect.) Shrinking brains, diminishing smarts: that’s the assumption. One researcher in the Discover piece argued that, “As complex societies emerged, the brain became smaller because people did not have to be as smart to stay alive.” (In other words: blame welfare.)

Cro-Magnon folk didn’t take WAIS tests, so it’s hard to assess this claim. And — here’s an unscientific argument! — it doesn’t fit with what I’m hearing from people I’ve talked to about this. If they feel they’re getting stupider, it’s because the world around them is getting so much more complicated than it used to be. If people have less ‘grey matter’ (and white matter, without which the famous grey stuff would be a splodge of useless gloop), they’re definitely doing more with it. Especially if they’re reading, watching or listening to the media.

Our modern anxieties may not be as severe as our Cro-Magnon ancestors’, but I find it hard to believe that those early humans had nearly as many of them. A modern person may not worry as much about survival (although too many still have to — a point it may be easier to overlook when you hail from the upper echelons of academia). But we moderns have huge fears about getting on, doing the right thing, keeping up with the neighbours, etc. etc.

Here’s a list of just a few of the modern anxieties we’re expected to concern ourselves with these days.

Computers — are they safe and secure? Are they destroying your health? What are all those updates actually doing to them? What are they doing, under those smooth bland surfaces? Can you trust online sites?

Privacy — do you have any left? If not, why aren’t you panicking? Go and read Paul Bernal.

Cars — should you feel guilty about damaging the planet? Or yourself? Cars are bad for the health.

Health — don’t even start. Driving’s the least of it: the list of what you should be doing, eating, drinking — or not — is endless.

Energy — almost all of it seems to be obtained in harmful or ethically dubious ways, except possibly the stuff you can’t afford.

Food — ditto. Are you eating meat? Eat less. Is your fish responsibly sourced? Are you sure? Are you a milk drinker or soya eater? Feel the guilt: you’re helping to ruin goodness knows how many environments.

Other goods — probably ditto. Why aren’t you taking the time to research who’s nice and who’s nasty in the corporate world?

International finance — any civilisation that thinks it’s a good idea to hand over its monetary systems to a gang of smart young computer buffs with less empathy than your average potato is surely doomed. We tried it; they gave us the Great Recession. Have we sent them to their bedrooms (or to jail) and cut their pocket money? Have we changed the system so they can’t do it again?

Careers — there’s someone on Twitter or Facebook who’s half your age and is bragging about doing twice as much. The sensible thing would be to pity them for having been brought up to be such a shameless vulgar narcissist, but chances are you’ll feel the social pressure and worry that you ought to be working even harder. (In all the spare time you aren’t using up pandering to all the other anxieties.)

International politics — it is highly likely that there is nothing you can do that will make any difference whatsoever to the multifarious stupid, nasty, disgusting and cruel human behaviours currently disgracing the planet. (I wrote a whole book about cruelty and what to do about it, and that didn’t make a difference that I know of. Odd, eh?). But you’re expected to know about them, worry about them, and maybe sign a petition or two. (It’s quicker than writing a book.)

Animals — I watched a TV programme about conservationists in Costa Rica trying to save a baby sloth. They failed. It was terribly sad. It was also one on a very long list of critters I’ve been told about and/or begged for cash to support.

People — even in one of the wealthiest nations on the planet, there seems to be a superabundance of poor/abused/wronged/sick adults and children to care about. And don’t forget concerns about immigration, people-trafficking, slavery and the like; there’s plenty more which could be added to that list.

With all that on his mind, I suspect that even the most brilliant Cro-Magnon genius might just curl up in a ball and start whimpering.

Today’s post is one of obligation rather than enjoyment. It needs saying, but it won’t be popular. It’s about Islamic State, ISIS, ISIL or however we’re currently translating what they call themselves: the repellent gang of criminals currently terrorising large swathes of the Middle East.

Not that the Western media would care half as much if that were all they were doing: but one of them, who has very publicly murdered an American journalist, has a British accent. He and a sizeable cohort of other alienated young men have gone off to fight for Islamic State; and we’re petrified that they’ll come back and start terrorising us.

It’s not the first time that young Brits have gone off to fight abroad. Many participated in the Spanish Civil War, for example, and we now see them as heroes; but that was different. For one thing, it didn’t involve the West’s long-time least favourite ideology: militant Islam.

Now, I’m a Western non-expert brought up in a still partly Christian culture and indoctrinated early on with the scientific belief system, so this is an outsider’s perspective, but as far as I can see the Islamic State ideology bears about as much relation to mainstream Islam as the Lord’s Resistance Army bears to mainstream Christianity. (An example of which is the quiet dignity under torment of James Foley’s family). In fact, to the untrained eye Islamic State looks rather a lot like the LRA, that deranged cult, especially in its members’ apparent conviction that they should kill anyone who doesn’t think like they do.

You don’t need a religion to believe that it’s OK to kill people, of course. But in this case, religion – very narrowly defined, quite likely by a person or persons of doubtful mental health – seems to be the marker being used to separate the saved from the massacred.

And guess what, we’re busy applying markers of our own. Viz. Philip Hammond, UK defence secretary: “This is a poison, a cancer, what’s going on in Iraq and Syria, and it risks spreading”.

Well, yes. Cancers do that, unless you in turn do some pretty nasty things to them. Like blitzing them with – er – poisons, or cutting them out. Calling Islamic State a cancer begs the question: what form of surgery is the defence secretary contemplating and how many British soldiers will die during the operation?

So here’s the unpopular message. Islamic State, like that other revolting entity Soylent Green, is made out of people. People like us, with devices and desires like us, who have somehow come to believe that the best thing they can do in life is commit atrocities.

Except you can bet that very few of them will actually believe that. Instead, they’ll believe that what they’re doing is a way to prove themselves, or a vile necessity, or justified vengeance, or self-defence, or even the only way to save themselves from a situation much nastier than they’d expected. Quite possibly some of the young Brits who went out to Syria and Iraq went for the adventure, or because someone they admired – someone they felt cared for them – asked them to go and implied they’d be cowards if they didn’t. Young men are terribly vulnerable to that kind of pressure. But it’s also likely that some went because they wanted to help, and then found themselves trapped and coerced by leaders who could see the propaganda value of having these foreign fighters on their side.

If you think of these ‘Jihadi Johns’ as terrorists, the instinctive response is to try and eliminate them. But that’s not an option, for several reasons. Firstly, we can’t find them all. Secondly, if we just summarily dispatch them, their younger brothers, cousins, best mates etc will be so enraged that we’ll have effectively bred a whole new clutch of enemies. We’ve seen Israel and Hamas pursuing this policy for years. Has it solved the Israel-Palestine conflict? No. (Has either side shown much sign of learning the obvious lesson? Again, no.) Furthermore, indiscriminate killing’s against the rules – the same rules which make the UK a generally law-abiding (and therefore extremely desirable) place to live.

If on the other hand you think of the Islamic State fighters as people, some of whom at least may not have gone out intending to kill innocents, then you start to see possible ways of starting to defuse the threat they pose, by draining their support. (Some of these are already being advocated, or even done, despite their lack of appeal to the media, because, I hope, many of those set over us don’t actually believe the rhetoric they feed to the tabloids.) For example:

Stop blathering on about ‘terrorists’. UK politicians these days are cagey about using the term ‘evil’, if only because it brings them such scorn from many quarters. But they hardly need it, since ‘terrorist’ now fills the gap – and has inherited much of the glamour and excitement of the older term, among people still immature enough to find violence exciting. Far better to make it seem childish, cowardly and contemptible – which killing unarmed innocents is, after all.

Give them an escape route – make it easier for those who are out of their depth and want to get away from Islamic State to do so. Have we done this? Or are we threatening to put them all in prison, whether or not they’ve actually committed atrocities?

Stick religiously to the rule of law. Don’t call them terrorists; instead refer – if you can, with weary patience – to criminals. Murderous criminals, yes, but we’ve come across those before. Make it clear that you, unlike their masters, will treat everyone fairly, however severe their crimes. State the punishments clearly, and by all means make them harsh; but state too that they will not be arbitrarily handed out, and that families and friends will not be made to suffer. And keep your promises.

Work on deradicalisation. The key is, again, to offer a way back to a decent life, albeit with strict terms and conditions. Boxing people into a corner is not going to encourage them to stop supporting Islamic State.

Ask some serious questions about why young men, and especially some young Muslims, feel the need to do this. Is society really as unfair and disrespectful to them as they seem to believe, or are their expectations unrealistic? If the latter, where do those expectations come from, and can we change them? Is the UK as fair in its foreign policy as it likes to pretend, or is perfidious Albion still being somewhat hypocritical? Why don’t these people have a stake in the UK? If they want respect, can we give it to them – or at least to the vast majority of them who don’t go off on bloodthirsty rampages? If those who do are being inflamed by tales of our past misdeeds, can we do anything to show we’re publicly sorry for past brutality – and will come down hard on anyone who does it again?

When you have some answers, act accordingly, and put some serious political will into the effort.

Once you think of the enemy as human, strategies for dealing with him open up. They involve a lot of effort, some of it painful and much of it counter-intuitive. But they have two great advantages over blitzing him, his neighbours and his kids. (Or demonising him, which makes the blitzing more probable – whatever the government says about “no boots on the ground”.) These strategies are a lot less striking, from a media perspective, and they make our leaders look much less aggressively heroic; but they reduce the risk of British soldiers dying. And, unlike aggressive heroism, they might reduce the risk to civilians too.

If this post has resonated with you, and you would like to know more, my book Cruelty offers more information.

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I’m prompted to write by a piece I’ve seen today on the BBC news website. It’s about a study in the journal Archives of Disease in Childhood (available in full here) which has found that children’s TV programmes – not the advertising, the programmes themselves – are as stuffed full of junk food as many of the kids who watch them.

As one of the researchers, Professor Clodagh O’Gorman, put it:

“Programmes have teenagers after school going to a coffee shop or fast-food outlet, having lots of sugary or high-fat foods and they’re all thin and happy, and that’s not realistic.”

Now, I don’t think the good professor is suggesting that every shot of a skinny teenager shovelling down a hamburger should be balanced by an image of some poor soul with obesity, diabetes, heart disease, dementia or cancer – but she has a point. (For more information, try these pieces from Scientific American.) Junk food is so named for a reason. It’s bad for you.

Especially in the quantities shown on television. The researchers basically watched kids’ TV for 5 days on the BBC and the Irish broadcaster RTE. They found one food cue on average every 4.2 minutes. Nearly half (47.5%) of all mentions of food were for unhealthy stuff, like sweets, and a quarter of drinks-mentions were for sugar-sweetened beverages.

Clever, clever food industry.

What particularly struck me was the comment by that most faceless of entities, a BBC spokesperson:

“We broadcast lots of programmes to promote healthy eating to children and to help them understand where food comes from, with series like I Can Cook, Incredible Edibles and Blue Peter.”

Now, this is either disingenuous or it shows a startling lack of understanding of basic psychology. Since the BBC knows enough psychology to put its comment at the end (thereby increasing its impact) … well, anyway, let’s give this respected media organisation the benefit of the doubt, and explain.

In my book Brainwashing, I talk about two kinds of ‘thought control’. Brainwashing by force is, if you like, the classic form: psychological torture, breaking someone’s resistance. Then there’s brainwashing by stealth, in which the persuader tries to slip ideas into someone’s mind without them noticing.

Take advertising, for instance. An ad for a car gives you an explicit message about how brilliant the car is; but you’re also getting unspoken messages about the kinds of people who own cars like this. You don’t see many car ads where the vehicle’s driven by elderly, ugly, sick or obviously poor people. There might be a buggy in the back, but a wheelchair?

Consumers may well not buy that specific car. But they’ll absorb the implicit messages about what society thinks is good and desirable, and all the better for not having the messages spelled out.

This study of child-specific TV programming found that food cues were much more likely to be linked to social rewards and good outcomes than to punishments and negative consequences. Unhealthy cues were presented for a shorter time, on average, than healthy ones. And overweight characters were much rarer than in real life. All of which sends the message – without saying so – that eating junk food is fine. More than fine: socially desirable and rewarding.

And so it may be, except that these childhood pleasures come with a hefty adult price tag (just ask the NHS).

If the BBC thinks that explicit messages about food health, presented in special programmes, are an effective way of balancing the stealthy persuasion uncovered by this research study, I’m afraid the BBC is wrong.

What is IDS?

IDS (Irritating Doggerel Syndrome) is a common and hugely under-diagnosed phenomenon. It afflicts all ages, though it may be more common in older people. The causes of IDS are not well understood and there is currently no treatment. However, recent research has opened up some promising avenues for future therapy (see Treatment, below).

Symptoms

IDS is characterised by obtrusive automatic thoughts in response to the perception of certain words or phrases (‘triggers’). These ‘autoresponses’ are similar to those which occur in depression, but they are not necessarily either self-related or negative in content. They are however often linked to negative emotionality, social anxiety and externalising behaviours, though the latter tend to be context-dependent.

The content of autoresponses typically incorporates cultural references such as lines from songs, advertising slogans, political soundbites or poems. (Note that the term ‘doggerel’ should be interpreted not as a judgement of cultural value, but as a reflection of the persistent, involuntary, and often unwanted nature of the thoughts.)

“The trouble is, once it starts, the whole lot goes through my head, as much as I know of it anyhow. Sometimes I find myself saying the words aloud, which is embarrassing. Especially the second verse of “The sun has got his hat on” – it’s terribly incorrect. Thank God I only know that one line from the Amii Stewart song.”

Example (Patient B, female, 45): “I’ve had IDS for years but never knew what it was. It’s such a relief to know it’s a recognised syndrome, even if they can’t cure it yet. Mine’s triggered by all sorts of things. For birds, I get, “Toity poiple boids, a-sitting on da koib, a-choiping, an’ a-boiping, an’ eating doity woims”. For buses, “What is it that roareth thus? Can it be a motor bus?” It does get in the way, because it’s hard to stop until you’ve said the thing through. And you have to be careful not to say it out loud.”

Example (Patient C, male, 33): “I’ve had severe IDS as long as I can remember. I was exposed to a lot of T.S. Eliot as a child, my dad loved his stuff. Not that Eliot wrote doggerel, but you can get a bit cheesed off with anything if it won’t stop. My friends are used to me suggesting we do things with, “Let us go then, you and I,” but it can be awkward with strangers – I’ve been known to greet random women with, “Lady, three white leopards sat under a juniper-tree!” My worst trigger is April. “April is the cruellest month, breeding lilacs out of the dead land …” The Waste Land>.

Causes

There is little research into IDS, but some studies have suggested that it is associated with education, cultural consumption, and with having wider social and cultural networks. Individual factors linked to IDS include the personality factor ‘Openness to Experience’, working in a language-related profession such as academia, and higher-than-average scores on tests of verbal intelligence and fluency. Some IDS patients are also particularly susceptible to ‘ear-worms’ – catchy tunes – but not all. Exposure to bad poetry, especially in youth and young adulthood, is a well-established risk factor. Parental occupation has also been linked to IDS, with children of writers, teachers and academics particularly at risk.

Mechanisms

It is thought that IDS involves over-activation of the brain’s semantic networks. Neuroimaging studies show activation of parietal and temporal brain areas involved in processing language and emotion. There are two major hypotheses of how IDS develops. Some researchers have suggested that the link between trigger and autoresponse is abnormally strengthened by, for example, concurrent strong emotion (the ‘Single Hit’ hypothesis). Others propose a more gradual formation, with weaker positive reinforcement repeatedly serving to strengthen the link (the ‘Slow Burn’ hypothesis). Most studies agree that positive, rather than negative, reinforcement is more likely to be involved in IDS.

Treatment

There is no current treatment for IDS. Studies are underway into whether methods developed to treat post-traumatic stress disorder may be effective. These involve altering intrusive memories, either with drugs, repetitive brain stimulation, or – as a last resort – deep brain stimulation. Anecdotally, some patients have found hypnosis helpful.

In the 1960s it was thought that IDS could be treated with aversion therapy: associating the trigger word with an alternative, highly unpleasant experience such as electric shock. However, this line of research was discontinued, on ethical grounds after some patients suffered serious side-effects, such as anxiety and psychosis.

In short, insufficient evidence currently exists to recommend any of these treatments.

Guidelines

Much clinical attention has therefore focused on prevention, rather than cure. Current guidelines for IDS patients, and for parents wishing to reduce the risk of IDS in their children, are as follows:

Parents should refrain from teaching their children poetry, or rewarding them if they recite it. Access to poetry books should be restricted. In many households this will already be the case, but Internet access should also be monitored.

Access to pre-2000 popular music should be restricted. (Much of the more recent music in this genre is entirely concerned with dance and rhythm, so the words tend to be inaudible or unmemorable, posing less of a risk for IDS.)

Listening to classical music should be encouraged, as any words are often foreign, or complicated, and are thus less easily remembered.

Media channels which carry advertising should be avoided. Any temporary discomfort will be offset by the increase in viewing quality.

People with severe IDS should be quarantined where possible, as the condition can be highly contagious.

If avoidance is not possible, at least try not to smile when someone with IDS says something bizarre. It only makes them worse.

Like this:

Owing to a technical fault, I have only just got back online. Yes, from Sunday to this morning I had no Internet access. No email, no Twitter, no Skype. No BBC news website, no science news updates. No iPlayer to download programmes I then forget, or don’t have time, to watch. No instant fact-check or query-satisfaction or just another look at the inbox.

I couldn’t even find out whether my niece’s hamster, boarded out while the family go on a proper holiday, can be safely left alone with a piece of cucumber, or should be restricted to carrot.

I exaggerate somewhat, because on Tuesday morning — Monday was a Bank Holiday here — a friend went back to work with a list of things to check. Of course, a good person shouldn’t be using work time to look up hamster diets. Then again, in my book a good person shouldn’t be using weekends, evenings, and national holidays for work, yet I’ve never heard the friend’s employers complaining. So they can put up with a little extramural research. (With such small steps is the path to corruption taken, but until my friend’s employers stop expecting apparently endless working hours, I’ll stay corrupt.)

I work at home. And BT take their bank holidays seriously, so they couldn’t possibly do anything about the problem for almost a whole working week. Or so they said. They sent me an email. I know this because the friend checked — another thing you’re not supposed to do. The email told me that they were investigating the problem. That’d be the same problem which stopped me checking email … at least, officially.

<sigh>

To be fair, they sent a “We know you’ve got a problem” text on Sunday. Then an engineer turned up, completely unannounced, this morning, just as I was about to brave the local library in a desperate hunt for internet facilities. Hey ho. They did fix the problem. We’ve stuck with BT for the reason Churchill recommended democracy: other telecoms firms have always looked worse. I’ll stay with that judgement for now.

There’s been one glorious upside to all this. I’m doing background research for a new book, and it hasn’t taken long to discover that the literature I ought to know about is catastrophically massive. Every week far more new articles come out than I can possibly read, and I’d already built up a to-do list of over 500 which I really ought to do something about. There’s no way this is going to happen, but at least this week I’ve started catching up on some of the backlog: ruthless weeding’s got it down to around 460.

People who don’t run internet providers or telecoms companies often say cutting down on internet use makes you more productive, happier — all the things you’re supposed to be when you’re not consuming news, being bullied by capitalism, chasing links across the web, and being distracted by cybertrivia. In four days, I can only hint at increased productivity, but maybe I should look into voluntarily restricting my internet access. Anyone know a good freeware programme that does this?

Like this:

Enthusiasm and its close friend excitement are the topic for this post.

<sigh>

There’s a lot of both about these days. The news is full of people being praised for their passion and commitment, from volunteers to athletes to science communicators. The media seethes with thrilling stories of ‘high drama’, from Ukraine to South Africa. Public discourse, it seems, is all about excitement; yet however much we have, we’re constantly being told we ought to have more. And that’s a problem, because excitement is not an unqualified Good Thing.

I knew this already, but if I hadn’t, writing a book on cruelty would have made it clear. Passion, after all, originally had to do with suffering. As for commitment, suicide bombers, war criminals, religious maniacs and other fanatics have tons of it. (Some cruelty is about thoughtlessness and lack of empathy, but not all.) Commitment to their beliefs can drive people to commit horrific atrocities. In the worst crimes, excitement — rather than sadism — is often an additional motive. Being cruel can really get the adrenaline going, and adrenaline’s a powerful drug.

Away from the terrible darkness of cruelty, however, there are more mundane reasons for wishing we could just all calm down a bit when it comes to this societal thirst for continual excitement. One is that, here in the West, we have ageing populations, and older people tend to prefer life to be less of an emotional roller-coaster. (Which adult, honestly, would go back to the agonies of childhood and adolescence, when everything mattered so intensely?) Another is that life’s too full of stuff already; we deal with far more, daily, than our grandparents had to think about.

Both those reasons, of course, may actually be driving the emphasis on excitement, as people long to stay young, or the competition for their attention gets fiercer. It’s also possible that the demand for thrills is a response to our increasingly safe and managed world, and perhaps to the feeling, well expressed by Paul Bernal, that much of that management rather dehumanises the managed.

Whatever the cause, there seems to be a prevalent expectation that excitement is, if not a human right, at least an ideal to which we should all aspire. Information by itself is not enough; it must be garlanded with gimmicks to catch the wandering consumer’s eye.

In my home territory of science, and in the news I sample every day, this is a potentially catastrophic problem. At its heart is a conflict between two domains: factual knowledge, and the media. It’s made worse by private ownership and the profit-motive, but even public sector organisations like the BBC are vulnerable to financial pressures for accountability, value-for-money and ratings. As indeed, increasingly, are public sector scientists.

The problem is simple. Media reporting is about what sells, or what boosts ratings. That constrains what is reported towards short, simple, highly salient (attention-grabbing) material. Since only unusual things are salient, the media is silent about most of everyday experience, and greatly distorts much of the rest. Yet the same media outlets are also presumed to reflect, in some way, how society is, and many people take their views about many things not from direct experience but from what they see on the telly, or read in the papers or online. The result: false beliefs all over the place.

This may seem old-fashioned, but news — including science news — shouldn’t be kow-towing to the impact agenda. It marches, or it should march, under a different flag, because what matters is not impact, but accuracy. Scientific findings aren’t true in the absolute sense in which ‘truth’ is often used; they’re not religious revelations or political convictions. But in the more ordinary sense of carefully trying to reflect reality, they’re far more true than a lot of media output.

For example, it’s irksome to see people talking, enthusiastically, about how exciting science is. Sure, once in a while. The rest of the time they could be hauled up before the Advertising Standards Authority for misdescription. I love science because it’s interesting, but interesting is not the same as constantly exciting (and my tastes are somewhat specialised). Not all science even manages to be interesting even to the scientists doing it, let alone the general public. Why should it? It’s not there to entertain, it’s there to figure out how the world works and help us work better in it.

Passion and commitment, so praised elsewhere, are an active danger for scientists. If your beloved theory is too beloved, you may not be able to see its flaws, and if it’s disproved, your commitment to it needs to stop. As for excitement, it’s often the most exciting papers that get the most publicity — and are then retracted. (Scientific misconduct is a problem that rarely makes the mainstream news.) Meanwhile, the boring stuff goes on quietly making progress.

As for the ability to communicate science, to bring out its interest for people who don’t know much about it, IMHO it has less to do with being exciting, and more with the ability to see the world from their point of view and make the topic relevant to them.

Excitement is over-rated. When it comes to science, and to news in general, it may be actively damaging. At the very least, we shouldn’t be letting it take priority over accuracy. Leave entertainment to the entertainers, drama to the dramatists, and commitment to anyone harmless. Science isn’t a cult. It doesn’t need more passion and excitement; if anything it’s got too much already. Passionate believers can lead a field astray and waste vast amounts of funding; thrilling tales can become distorting myths; high drama can distract from accurate research. (The same goes for news.) Better to treat our sciences the way we should be treating other areas of knowledge: with care, doubt, and in-depth investigation. And if that doesn’t sound totally thrilling … well, so what?

Like this:

A study making headlines today in the Journal of Occupational Health Psychology suggests that having a mentally demanding job before you retire is associated (in about 4000 Americans) with “higher levels of cognitive functioning before retirement, and a slower rate of cognitive decline after retirement”. Use it or lose it, in short.

And who wants to lose it? A retirement spent blowing the kids’ inheritance on having fun is one thing; a retirement blighted by stroke or dementia is quite another.

A letter to my local paper last week, meanwhile, remarked on the way we insist on people ‘finding jobs’, even as companies increasingly use technology to replace them. Or to shift the work elsewhere: the forms which would once have been filled by a secretary are often now completed by customers, online.

Which got me thinking — as I and many before me have thought — about work and the way we organise it.

Frankly, it’s rather silly. The timing’s inept, the concept old-fashioned, and the execution often cruel. For much of history this hasn’t mattered, as there’s been plenty of work to go around; also many people didn’t live long enough to worry about retirement. But things are changing, as the available labour shrinks. And not only shrinks, but shifts towards two extremes: the much-puffed ‘knowledge economy’, and the rest.

‘high-end’ jobs pay relatively well and demand a lot of skills and brainpower (e.g. university teachers and researchers). They also have high workloads and long hours;

more manual jobs, which we can’t yet replace with technology, are typically much lower-paid, despite the fact that it’s hard to see how caring for the sick and elderly is less important than teaching kids why Hamlet, or quantum mechanics, matters. Of course, you don’t need extensive training to be a carer.

(We might infer that high pay is perhaps a reward for time invested in previous study? — except that investment bankers can earn far, far more than university lecturers. Is it then a reward for effort, or physical labour? Tell that to a farmer. For danger? Ask a fireman. For being brilliant and/or irreplaceable? That’s what the most highly-paid often seem to be saying, but there’s very little evidence that they’re right.)

There’s less work to go round, especially for those without the best qualifications. And what work there is doesn’t always pay enough to live on. The private sector is on a win-win here. They can get away with paying low wages because the state will fill the gap. They can hike rents, or drive up house prices, because that’s ‘the free market’. They can make profits by pushing their costs onto others, and still whinge about the tax they have to pay — when much of that tax goes on payments that wouldn’t be needed if they weren’t so utterly focused on making money.

In Britain, we hark back to the days when great companies built houses for their workers, or gave their kids schools. That kind of philanthropy may still go on, but we don’t hear much about it. Instead we hear a lot about companies who seem to live by the ancient Roman principle: “homo homini lupus” (“Man is a wolf to man.”) And they have the cheek to complain about government ‘red tape’! Guys, if you behaved better we wouldn’t need to impose the regulation on you — and on everyone else.

As work becomes scarcer, the rhetoric of its desirability intensifies. You’d think humans lived entirely and only to work. The unemployed are stigmatised, their benefits decried (yet the far more expensive pensions of the elderly are OK, because they earned their rewards). Kids are so indoctrinated with the need to find a job that they spend much of their childhood cramming, agonising over exams, struggling with homework, knowing they have to achieve — at a time when they’re dealing with the massive social pressures of growing up. Small wonder some drop out. People who can’t work feel dreadful guilt. Some who lose their jobs are driven to suicide.

There’s something pitiful about a first-year university English Literature student distraught because she’s “wasted time” reading Wuthering Heights when it wasn’t on her course. Or a seventeen-year-old whose only idea about all the cultural riches available to them is how to get work that will pay them enough to buy lots of stuff. Come to that, there’s something pitiful about a middle-aged adult lying awake at night worrying about how they’ll cope with both a sick parent and the demands of running their own household, while working all the hours their job demands. And there’s certainly much to be pitied in the lonely senior, deprived by retirement of company and stimulation, or the hard-working tax-payer who, as they reach retirement, is diagnosed with some appalling illness, like dementia.

Why do we do it this way? It’s bad for our brains, our health and our happiness. At the time of life when we are most able to enjoy ourselves, some of us are working ridiculous hours while others face empty days. Women lose out if they have kids, especially if they choose not to deposit the sprogs in childcare. Some people aren’t paid enough to live on; others earn far more than any human being could reasonably need. Then we reach retirement age, and suddenly that’s it: we’re pensioned off, our productive days over. Yet creativity doesn’t cut out at sixty-five, nor intelligence shrivel at seventy. A man who turns 65 in the UK can expect to live a further 17.8 years, a woman 20.4 years, according to the Office for National Statistics. That’s a lot of years to write off, especially with an ageing population.

There are many ways in which we could change this mess. Most of them are extremely unlikely to happen, not least because the mess didn’t come about by accident. It suits the people in charge, insofar as anyone’s in charge. Yet it may be worth stating some options anyway, if only because they’re far too radical for serious politics and so aren’t often heard. (I’m not a politician, so I don’t need to be serious.)

Make the private sector pay its way. Rent caps (why should taxpayers spend masses on housing benefits so that landlords can get rich?). Tackling tax evasion and business subsidies. Redistribution: in the UK this year, a few lucky bankers collected over £5 million each from Barclays Bank. Why are they worth 50 times what we pay our most senior nursing directors, let alone frontline nurses?

Encourage job-sharing, volunteering, hobbies and part-time work. Make it acceptable for people of both sexes to take career breaks in midlife. Pay parents better: bringing up kids is hard work. Defusing the social pressures around work and worklessness with clear financial incentives would do wonders for the nation’s health bill, apart from its other benefits.

Rethink education. Currently it’s mostly stuffed into our youngest years, and some of it’s pretty irrelevant to most adults. It should be lifelong, as much a part of our routine as running a bank account. That old canard about brain development ceasing around 18 is nonsense.

A living wage and/or minimum income guarantee (discussed here in the US context). Many people who’d like to volunteer can’t afford to; many who can afford to can’t spare the time. Making sure that everyone has a minimum guaranteed income to live on would help with at least the first of these problems, as well as reducing the devastating costs of stress-induced mental illnesses. It would also save on the gigantic benefits bill, not least because it would be a good deal simpler to administer than current systems.

High-end jobs like running a university, company or bank may be extremely hard and stressful, but the work itself is not intrinsically unpleasant or dangerous (except insofar as the sedentary lifestyle brings health risks). Jobs which are unpleasant and dangerous should be paid more, or workers given a tax break, to express the nation’s gratitude that we don’t have to do this stuff. And if that study I mentioned is correct, perhaps we should be targeting the financial rewards towards encouraging workers to continue their education.

Abolish retirement except on health grounds. If work — in moderation — is so good for us, we shouldn’t be driving people away from it. If there’s less work to go round, we need to be more creative in how we organise it — because there’s plenty to do; it’s just that much of it isn’t currently paid work. Making high-end jobs less demanding and low-end work more interesting, and giving people more life space to do unpaid work, would make retirement look less attractive, as well as providing benefits for workers and society.

Work is bound up with many half-acknowledged ideas: about fairness and reciprocity, status and identity. While there was plenty of it, there wasn’t much need to examine its rationales, and how deep-seated feelings and ways of thinking affect them. But work is changing, and we need to change our ideas about work.